Provider Demographics
NPI:1881874196
Name:DR. ELISSA M. CONTILLO INC
Entity type:Organization
Organization Name:DR. ELISSA M. CONTILLO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-421-4821
Mailing Address - Street 1:671 ATWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5322
Mailing Address - Country:US
Mailing Address - Phone:401-421-4821
Mailing Address - Fax:401-421-0928
Practice Address - Street 1:671 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5322
Practice Address - Country:US
Practice Address - Phone:401-421-4821
Practice Address - Fax:401-421-0928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007907Medicaid
RIT79193Medicare UPIN
RI6488480001Medicare NSC